August 7, 2000

It's 6 am, and while the streets of Boston are just coming to life, Cynthia Cooper, MD, has already started her day. In the semi-darkened nursing station of White 9, she checks to see who was admitted overnight.

"I can't imagine we only got one admission last night," she says, looking skeptically at the notes left by the first-year resident on the night shift. "That's highly unlikely."

She pages the on-call resident. He is with a patient and has had very little sleep. It turns out there were four admissions overnight. Cooper quickly writes medical notes because by 7 am, Bigelow Team A – three first-year residents (or interns), three medical students and a pharmacy intern – will gather to start morning rounds on the medical floors under the guidance of Cooper, their team leader. They will see 10 to 25 patients in three hours, checking vital signs, talking to patients and recommending treatment. This is part of the process of becoming a doctor. The residents have spent four years poring over textbooks, listening to lectures, absorbing and memorizing terms, learning to speak the language of medicine. Now they are physicians, in their first few weeks of residency.

Cooper, as a second-year, or junior, resident, is an important teacher for the team. After examining a patient, she asks the interns to recommend treatment. She prompts them, corrects them, chastises them, praises them. "You have to keep your eye on the ball," Cooper explains. "The older you get and the more experienced you are, the more you're able to filter through to the problem at hand. That's what the junior does for the intern and the attending physician does for the junior."

Such is the continuous pyramid of teaching that is the backbone of the MGH. It dates back to the very origins of the hospital, when it was founded to provide training for new graduates of Harvard Medical School. At the time, there was no general hospital in New England. Doctors made house calls to those who could afford it, and young physicians were thrown into practice with virtually no real-life experience.

Today, the MGH still is a training ground for Harvard students, and accepts applicants from medical schools all over the world into 20 residency programs and approximately 80 fellowship programs. Currently, there are about 1,050 residents and clinical fellows. The MGH's residency program is one of the most competitive – 4,000 people inquire each year about training in Internal Medicine alone, while only 40 to 50 are accepted.

The length of residency depends on the specialty. For internal medicine, it's three years. For radiology, four years. For general surgery, five years, with additional training in subspecialties. For child psychiatry, one or two years in internal medicine or pediatrics, then four years in adult psychiatry and another two years in child psychiatry. Georgi Bland, manager of MGH Graduate Medical Education, compares residency to a boot camp.

"They work incredibly long hours for little pay, and without them, the star faculty couldn't do what they do. The faculty here are as productive as they are because the residents do the basics for them and support their activities in ways the public may not even recognize," Bland says.

The residents care for nearly all of the hospital's inpatients. They are constantly supervised by more experienced physicians, who scrutinize every decision they make. Residents are given more and more independence as they advance through their training programs.